Staging

Criteria for TNM Clinical Staging: Physical examination and history, palpation of abdomen, abdominal imaging, endoscopy, colposcopy, endocervical curettage, fractional curettage, sounding of uterine cavity, intravenous urography, imaging for distant metastases, and histologic confirmation of malignancy

Criteria for TNM Pathologic Staging: Hysterectomy with or without dissection of pelvic lymph nodes.

Staging for uterine tumors applies only to carcinomas.

Placental Tumors

The US Trophoblastic Disease Centers have developed a clinical staging system based on the following criteria:

• Duration of disease
• Presence of liver or brain metastases
• HCG titer level
• Treatment with chemotherapy
• Occurrence after a full-term pregnancy

Cases are grouped into nonmetastatic and metastatic, which is further subdivided into low risk and high risk.

• Nonmetastatic: tumor confined to the uterus
• Metastatic, good prognosis: last pregnancy less than 4 months
• prior;HCG titer low; no liver or brain metastases; no prior chemotherapy
• Metastatic, poor prognosis: last pregnancy more than
• 4 months prior; high HCG titer; liver or brain metastases;
• prior chemotherapy; occurrence after a full-term pregnancy

A second system proposed by the World Health Organization is a scoring system that determines low-, medium- and high-risk patients, based on such factors as age, previous pregnancy, HCG titer, blood group, size of tumor, metastatic sites, number of metastases, interval between end of previous pregnancy and start of chemotherapy, and history of chemotherapy.

The TNM staging system for Gestational Trophoblastic Tumors is new in the fifth edition.

Brief Summaries of 5th Edition Categories

Risk Factors

• HCG > 100,000 IU/24 h urine
• detection of disease > 6 months from pregnancy

Collaborative Stage Elements

For more details on Collaborative Stage, see the Intro to Collaborative Staging module.